van Hooijdonk Carolien, Droomers Mariël, van Loon Jeanne A M, van der Lucht Fons, Kunst Anton E
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Soc Sci Med. 2007 Mar;64(6):1326-42. doi: 10.1016/j.socscimed.2006.10.041. Epub 2006 Dec 21.
In general, inhabitants of low socio-economic areas are unhealthier than inhabitants of high socio-economic areas, but some areas are an exception to this rule. These exceptions imply that other factors besides the socio-economic level of an area contribute to the health of the inhabitants of an area, e.g. environmental factors. In our study we concentrate on areas within the Netherlands that are healthier or unhealthier than could be expected based on their socio-economic level. This study first identifies these areas and secondly determines which area characteristics distinguish these areas from those areas where the level of health is in agreement with their socio-economic level. We used nation-wide data on neighbourhood differences in population composition (gender, age, marital status and ethnicity), urbanisation and two health indicators: mortality and hospitalisation rates. In the Netherlands, many areas are healthier or unhealthier than could be expected based on their income level alone. Areas with higher mortality rates than expected are mainly urban areas with high percentages of elderly people and persons living alone. Similar but opposite associations are observed for areas with lower mortality rates than expected, which are further characterised by a low percentage of non-western immigrants. Areas with lower hospitalisation rates than expected are mainly rural areas with few non-western immigrants. From these results, we conclude that urbanisation and residential segregation based on age, ethnicity and marital status might be important contributors to geographical health inequalities.
一般来说，社会经济地位较低地区的居民比社会经济地位较高地区的居民健康状况更差，但有些地区是这一规律的例外。这些例外情况表明，除了一个地区的社会经济水平之外，其他因素也会影响该地区居民的健康，例如环境因素。在我们的研究中，我们关注的是荷兰境内那些基于其社会经济水平而言健康状况好于或差于预期的地区。这项研究首先要识别出这些地区，其次要确定是哪些地区特征将这些地区与那些健康水平与其社会经济水平相符的地区区分开来。我们使用了全国范围内关于邻里人口构成差异（性别、年龄、婚姻状况和种族）、城市化以及两个健康指标的数据：死亡率和住院率。在荷兰，许多地区基于其收入水平而言健康状况好于或差于预期。死亡率高于预期的地区主要是老年人和独居者比例较高的城市地区。对于死亡率低于预期的地区，观察到了类似但相反的关联，这些地区的进一步特征是西方以外的移民比例较低。住院率低于预期的地区主要是西方以外移民较少的农村地区。从这些结果中，我们得出结论，基于年龄、种族和婚姻状况的城市化和居住隔离可能是导致地理上健康不平等的重要因素。
